Trauma-informed Treatment for Refugee PTSD

Participants included refugees referred to the Rehabilitation Center for Trauma Survivors (RCT), a specialized treatment clinic for PTSD in Haderslev, Denmark. All participants were referred by private practitioners or psychiatrists for assessment and treatment of PTSD. Participants were offered treatment if they met the inclusion criteria: trauma-related mental health problems, often PTSD in combination with comorbid mental and physical health problems. Referred refugees were not offered treatment if they were suffering from psychotic disorders, were actively suicidal, or did not have a legal stay in Denmark. Referred patients who did not meet the inclusion criteria for treatment were subsequently referred to other relevant treatment in coordination with the patient’s private practitioner. All patients offered treatment at RCT from December 2015 to March 2022 were enrolled in an assessment programme, including the ITQ at intake (baseline). Dropouts from the assessment programme were offered the same treatment as those participating in the assessment programme. Data from 490 patients were included in this study. The mean age of the participants was 41.9 years (SD 10.47). Further demographic characteristics of the study sample are shown in Table 1, and the prevalence of types of trauma reported by the participants with the ITQ is included in Table 2.
Table 1.

Demographic characteristics of the study sample.

Characteristic	n	%
Agea
17–37 years	165	33.7
38–47 years	172	35.1
48–76 years	153	32.1
Gendera
Male	264	53.9
Female	226	46.1
Diagnosisb
No PTSD	49	10.0
PTSD	103	21.0
CPTSD	338	69.0
Country of origin
Syria	247	50.4
Bosnia	67	13.7
Afghanistan	42	8.6
Kosovo	31	6.3
Lebanon	18	3.7
Iraq	16	3.3
Iran	10	2.0
None of the above	59	12.0
ITQ language/spoken languagea
Danish/Danish	205	41.8
Arabic/Arabic	183	37.3
Bosnian/Bosnian	32	6.5
Danish/Arabic	70	14.3
Assistance from interpreter or cliniciana
None	97	19.8
Few clarifications	181	36.9
Read aloud and many clarifications	73	14.9
Read aloud and formulated answers	106	21.6
Missing	33	6.7
Time since trauma exposurea
Up to 5 years	121	24.7
5–10 years	136	27.8
≥ 10 years	233	47.6

Note: ^aExogeneous variables included in the differential item functioning (DIF) analysis. ^bBy the suggested International Trauma Questionnaire (ITQ) diagnosis algorithms.

PTSD, post-traumatic stress disorder; CPTSD, complex post-traumatic stress disorder.

Table 2.

Type and prevalence of traumatic events in the study sample.

Type of traumatic event	Frequency
War and flight	363
Imprisonment or kidnapping	42
Torture (physical and psychological)	18
Violence	13
Witnessing violence (including executions)	11
Loss and death among close relations	7
Rape or sexual abuse	7
Social problems (e.g. issues regarding legal stay in Denmark, family disputes)	6
Symptoms (e.g. reporting depression as the trauma)	4
Other	19

Note: The categorization is based on what the patients filled out as the first, and sometimes only, trauma in the open-ended question in the International Trauma Questionnaire (ITQ). Thus, if the patient has reported violence as the first trauma, this was categorized as violence. The table cannot be considered to provide an adequate account, as, for example, the clinicians know that more than 18 people in the group has suffered torture. We nevertheless chose this categorization, as the ITQ only asks for a single trauma, and even an attempt to categorize multiple traumas would thus also have been incomplete.